Ethical problems: In the face of sudden and unexpected death

2011 ◽  
Vol 19 (5) ◽  
pp. 642-653 ◽  
Author(s):  
Åsa Rejnö ◽  
Linda Berg ◽  
Ella Danielson
Keyword(s):  
Ethical Issues ◽  
Mutual Trust ◽  
Next Of Kin ◽  
Best Interest ◽  
Unexpected Death ◽  
Ethical Problems ◽  
Team Members ◽  
Stroke Team ◽  
The Face ◽  
Group Interviews

When people die suddenly and unexpectedly ethical issues often come to the fore. The aim of the study was to describe experiences of members of stroke teams in stroke units of ethical problems and how the teams manage the situation when caring for patients faced with sudden and unexpected death from stroke. Data were collected through four focus group interviews with 19 team members in stroke-unit teams, and analysed using interpretive content analysis. Three themes emerged from the analysis characterized by information, decisions about care and support for the next-of-kin in the changing and uncertain situation, with mutual trust as the core. Mutual trust, both within the stroke team and with next-of-kin was seen by the stroke-team members as a way of handling ethical problems by administering care with the patient’s best interest at heart.

Strategies for handling ethical problems in sudden and unexpected death

2013 ◽  
Vol 20 (6) ◽  
pp. 708-722 ◽  
Author(s):  
Åsa Rejnö ◽  
Ella Danielson ◽  
Linda Berg
Keyword(s):  
Content Analysis ◽  
Qualitative Content Analysis ◽  
Unexpected Death ◽  
Ethical Problems ◽  
Team Members ◽  
Individual Interviews ◽  
Follow Up Study ◽  
Stroke Team

How ethical praxis is shaped by different contexts and situations has not been widely studied. We performed a follow-up study on stroke team members’ experiences of ethical problems and how the teams managed the situation when caring for patients faced with sudden and unexpected death from stroke. A number of ways for handling ethical problems emerged, which we have now explored further. Data were collected through a three-part form used as base for individual interviews with 15 stroke team members and analyzed using both quantitative and qualitative content analysis. In the analysis, the approaches in the form were condensed into strategies, and the two different ways those strategies were preferred and used by the team members were shown. Hindrances perceived by the team members to impede them from working the preferred way were also revealed and grouped into eight categories.

Strategies for handling ethical problems in end of life care: obstacles and possibilities

2014 ◽  
Vol 22 (7) ◽  
pp. 778-789 ◽  
Author(s):  
Åsa Rejnö ◽  
Linda Berg
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Ethical Reasoning ◽  
Best Interests ◽  
Life Care ◽  
Unexpected Death ◽  
Ethical Problems ◽  
Team Members ◽  
Starting Point ◽  
Stroke Team

Background: In end of life care, ethical problems often come to the fore. Little research is performed on ways or strategies for handling those problems and even less on obstacles to and possibilities of using such strategies. A previous study illuminated stroke team members’ experiences of ethical problems and how the teams managed the situation when caring for patients faced with sudden and unexpected death from stroke. These findings have been further explored in this study. Objective: The aim of the study was to illuminate obstacles and possibilities perceived by stroke team members in using strategies for handling ethical problems when caring for patients afflicted by sudden and unexpected death caused by stroke. Research design: A qualitative method with combined deductive and inductive content analysis was utilized. Participants and research context: Data were collected through individual interviews with 15 stroke team members working in stroke units of two associated county hospitals in western Sweden. Ethical considerations: The study was approved by the Regional Ethics Review Board, Gothenburg, Sweden. Permission was also obtained from the director of each stroke unit. Findings: All the studied strategies for handling of ethical problems were found to have both obstacles and possibilities. Uncertainty is shown as a major obstacle and unanimity as a possibility in the use of the strategies. The findings also illuminate the value of the concept “the patient’s best interests” as a starting point for the carers’ ethical reasoning. Conclusion: The concept “the patient’s best interests” used as a starting point for ethical reasoning among the carers is not explicitly defined yet, which might make this value difficult to use both as a universal concept and as an argument for decisions. Carers therefore need to strengthen their argumentation and reflect on and use ethically grounded arguments and defined ethical values like dignity in their clinical work and decisions.

Reasoning about truth-telling in end-of-life care of patients with acute stroke

2016 ◽  
Vol 24 (1) ◽  
pp. 100-110 ◽  
Author(s):  
Åsa Rejnö ◽  
Gunilla Silfverberg ◽  
Britt-Marie Ternestedt
Keyword(s):  
Acute Stroke ◽  
End Of Life ◽  
End Of Life Care ◽  
Common Morality ◽  
Life Care ◽  
Best Interest ◽  
Truth Telling ◽  
Team Members ◽  
Individual Interviews ◽  
Stroke Team

Background: Ethical problems are a universal phenomenon but rarely researched concerning patients dying from acute stroke. These patients often have a reduced consciousness from stroke onset and thereby lack ability to convey their needs and could be described as ‘incompetent’ decision makers regarding their own care. Objective: The aim of the study was to deepen the understanding of stroke team members’ reasoning about truth-telling in end-of-life care due to acute stroke. Research design: Qualitative study based on individual interviews utilizing combined deductive and inductive content analysis. Participants and research context: A total of 15 stroke team members working in stroke units of two associated county hospitals in western Sweden participated. Ethical considerations: The study was approved by the Regional Ethics Review Board, Gothenburg, Sweden. Findings: The main findings were the team members’ dynamic movement between the categories ‘Truth above all’ and ‘Hide truth to protect’. Honesty was highly valued and considered as a reason for always telling the truth, with the argument of truth as common morality. However, the carers also argued for hiding the truth for different reasons such as not adding extra burden in the sorrow, awaiting a timely moment and not being a messenger of bad news. Withholding truth could both be seen as a way of protecting themselves from difficult conversations and to protect others. Discussion: The results indicate that there are various barriers for truthfulness. Interpreted from a virtue of ethics perspective, withholding of truth might also be seen as an expression of sound judgement to put the patient’s best interest first. Conclusion: The carers may need support in the form of supervision to be given space to reflect on their experience and thereby promote ethically justified care. Here, the multi-professional team can be of great value and contribute through inter-professional sharing of knowledge.

scholarly journals Moral sensitivity components identified among nurses from Intensive Care Units

2019 ◽  
Vol 72 (suppl 1) ◽  
pp. 2-8 ◽  
Author(s):  
Cláudia Denise Schallenberger ◽  
Jamila Geri Tomaschewski-Barlem ◽  
Edison Luiz Devos Barlem ◽  
Laurelize Pereira Rocha ◽  
Graziele de Lima Dalmolin ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Professional Autonomy ◽  
Moral Perception ◽  
Moral Sensitivity ◽  
Structured Interviews ◽  
Ethical Problems ◽  
Team Members ◽  
The Face ◽  
South Of Brazil

ABSTRACT Objective: to identify ethical problems from the components of moral sensitivity among nurses of Intensive Care Units. Method: qualitative, exploratory-descriptive study developed in a hospital in the South of Brazil with 19 nurses working in intensive care units through semi-structured interviews that were analyzed through discursive textual analysis. Results: ethical education, dialogue, relationships with other health team members, professional autonomy, knowledge, personal values, effective communication, leadership and patients' positive outcomes were identified as important components of nurses' moral sensitivity, and comprise the domains of moral consciousness, benevolent motivation, and spontaneous moral perception. Final considerations: the components of moral sensitivity identified in this study facilitate nurses' instrumentalization in the face of decision making and ethical problems in the intensive care setting.

Semantic, Political and Moral Issues Connected with Giftedness

1983 ◽  
Vol 1 (2) ◽  
pp. 89-91 ◽  
Author(s):  
Tom Marjoram
Keyword(s):  
Ethical Issues ◽  
Early Age ◽  
Moral Issues ◽  
Ethical Problems ◽  
The Face ◽  
Classroom Materials ◽  
Special Provision ◽  
Contrary Evidence

Much research has been done on the identification and provision for gifted pupils in schools. Although schools are more aware of and sympathetic to the needs of gifted pupils than they were and although a great variety of challenging classroom materials have been developed, certain issues remain unresolved. The definition and terms used are still confusing and misunderstood; several have acquired pejorative overtones. Certain myths persist in the face of contrary evidence; views are too often polarized. Ethical issues perplex sensitive bright children at an early age and there are also ethical problems associated with identification, special provision and segregation that require resolution. The time has come for a sterner look at these issues and a careful stocktaking and review of all the work and progress to date.

Coercion in nursing homes

2015 ◽  
Vol 23 (3) ◽  
pp. 253-264 ◽  
Author(s):  
Elisabeth Gjerberg ◽  
Lillian Lillemoen ◽  
Reidar Pedersen ◽  
Reidun Førde
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Next Of Kin ◽  
Best Interest ◽  
Focus Group Interviews ◽  
Ethical Considerations ◽  
Individual Interviews ◽  
Nursing Home Patients ◽  
Legal Challenges ◽  
Group Interviews

Background: Studies have demonstrated the extensive use of coercion in Norwegian nursing homes, which represents ethical, professional as well as legal challenges to the staff. We have, however, limited knowledge of the experiences and views of nursing home patients and their relatives. Objectives: The aim of this study is to explore the perspectives of nursing home patients and next of kin on the use of coercion; are there situations where the use of coercion can be defended, and if so, under which circumstances? Methods: The data are based on individual interviews with 35 patients living in six nursing homes and seven focus group interviews with 60 relatives. Ethical considerations: Participation was based on written informed consent, and the study was approved by the Regional Committees for Medical and Health Research Ethics. Results: More than half of the patients and the majority of the relatives accepted the use of coercion, trusting the staff to act in the patient’s best interest. However, the acceptance of coercion is strongly related to the patients’ lack of understanding, to prevent health risks and to preserve the patient’s dignity. Conclusion: The majority of nursing home patients and relatives accepted the use of coercion in specific situations, while at the same time they emphasised the need to try alternative strategies first. There is still a need for good qualitative research on the use of coercion in nursing homes, especially with a closer focus on the perspectives and experiences of nursing home patients.

scholarly journals European Psychiatric Association policy paper on ethical aspects in communication with patients and their families

2020 ◽  
Vol 63 (1) ◽  
Author(s):  
Bernardo Carpiniello ◽  
Danuta Wasserman
Keyword(s):  
Clinical Practice ◽  
Ethical Issues ◽  
Relevant Literature ◽  
Ethical Aspects ◽  
Best Interest ◽  
Dual Roles ◽  
Ethical Problems ◽  
Policy Paper ◽  
Ethical Commitment ◽  
Association Policy

Abstract Background. Establishing a valid communication is not only a basic clinical need to be met but also a relevant ethical commitment. Methods. On the basis of the relevant literature, ethical issues arising from specific, important situations in clinical practice were identified. Results. The main ethical problems regarding communication about the disorder, both in general and in relation to prodromal stages, were described and discussed together with those regarding communication about voluntary and involuntary treatments, “dual roles” enacted in clinical practice, genetic counseling, and end-of-life conditions; on the basis of what emerged, ethically driven indications and suggestions were provided. Conclusions. Several situations put the psychiatrist in front of relevant dilemmas and doubts which are no easy to face with; an ethically driven approach based upon the principle of the best interest of patients may support clinicians in their decisions.

Utilising Indigenous Knowledge or Crime against Humanity?: A Critical Engagement with the Debate Generated by Alick Macheso’s Use of Manhood to Treat Nhova (Sunken Fontanelle)

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Charles Tembo ◽  
Allan Maganga ◽  
Peterson Dewah
Keyword(s):  
Ethical Issues ◽  
General Tendency ◽  
Ethical Values ◽  
Ethical Considerations ◽  
Lower Back ◽  
African Ethics ◽  
Cultural Grounding ◽  
The Face ◽  
Left And Right ◽  
Points Of View

 This article presents various points of view regarding the treatment of sunken fontanelle by various communities as ignited by the controversial practice of kutara(a practice that involves the father of a child sliding his penis from the lower part of the left and right cheeks to the top of the head, as well as from the lower part of the face to the top of the head, and from the lower back part of the head to the top). The story of Alick Macheso’s use of his manhood to treat nhova (sunken fontanelle) opened a Pandora’s box. The story not only attracted the attention of critics from diverse cultural and ethical backgrounds, but revealed multi-ethnic positions. That is, reactions were steeped in a multiplicity of intellectual, religious and even cultural grounding. Reactions ranged from accusations of backwardness and absurdity, through to medical and Christian orientations toward the treatment of nhova. The overarching idea is that there is a general tendency to dismiss the age-old practice of kutara,coupled with an uncritical celebration of certain positions. The debate that ensued following publication of the story seemed to revolve around ethical considerations. The school of thought that dismisses kutara with disdain regards it as unethical and unimaginable in the present-day world—it is redolent with insinuations of absurdity on the part of those that live and celebrate it. We contend that the raging debate that followed the publication of the story can best be conceptualised within the context of African ethics. We note that kutara has relevance to the spirituality, ethical values, privacy, and protection of children’s rights, among other ethical issues. It is hoped that the article will stir further debate and encourage more research among information practitioners, scholars and researchers into the ethical issues surrounding the treatment of sunken fontanelle in various African communities. It argues for an Afrocentric conceptualisation of phenomena in order to contribute to debates on the renaissance of African cultures, and stresses that it is imperative to harness the life-furthering age-old traditions in African ontological existence.

Using Biomedical Ethics Model to Explore Use of Postmortem Specimens in Tissue Research

2016 ◽  
Vol 3 (1) ◽  
pp. 234-237
Author(s):  
Stacy A. Drake ◽  
Erica T. Yu
Keyword(s):  
Ethical Issues ◽  
Biomedical Ethics ◽  
Human Tissues ◽  
Next Of Kin ◽  
Policy Makers ◽  
Institutional Review ◽  
Tissue Procurement ◽  
Tissue Research ◽  
Death Investigation ◽  
Medicolegal Death Investigation

Researchers often have a need to conduct human tissue research using postmortem specimens. Medicolegal death investigation organizations are untapped areas for obtaining postmortem human tissues. Because death investigation organizations are not required by law to conduct or support research, an ethical dilemma exists in whether or not researchers should use cadaver tissues for research purposes. This paper analyzes the ethical issues of using human tissues through discussion of principles of biomedical ethics, respect for autonomy, nonmaleficence, beneficence, and justice. Policy makers, organ and tissue procurement organizations, medicolegal death investigation organizations, and scientists should be aware of these principles when considering researchers requests. The authors conclude that with Institutional Review Board approval and next of kin consent, there are prevailing reasons for using postmortem tissue for research.

Pandemic Disease, Public Health, and Ethics

2019 ◽  
pp. 796-811 ◽  
Author(s):  
Maxwell Smith ◽  
Ross Upshur
Keyword(s):  
Public Health ◽  
Ethical Issues ◽  
Ethical Challenges ◽  
Pandemic Preparedness ◽  
Scarce Resources ◽  
Ethical Frameworks ◽  
Health Measures ◽  
Care Workers ◽  
The Face ◽  
Conducting Research

Infectious disease pandemics raise significant and novel ethical challenges to the organization and practice of public health. This chapter provides an overview of the salient ethical issues involved in preparing for and responding to pandemic disease, including those arising from deploying restrictive public health measures to contain and curb the spread of disease (e.g., isolation and quarantine), setting priorities for the allocation of scarce resources, health care workers’ duty to care in the face of heightened risk of infection, conducting research during pandemics, and the global governance of preventing and responding to pandemic disease. It also outlines ethical guidance from prominent ethical frameworks that have been developed to address these ethical issues and concludes by discussing some pressing challenges that must be addressed if ethical reflection is to make a meaningful difference in pandemic preparedness and response.

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